CN1972647B

CN1972647B - Systems and techniques for restoring and maintaining intervertebral anatomy

Info

Publication number: CN1972647B
Application number: CN2005800032798A
Authority: CN
Inventors: K·T·福雷; J·D·摩尔; J·P·邓肯; S·M·哈德多克; T·A·西蒙敦
Original assignee: Warsaw Orthopedic Inc
Current assignee: Warsaw Orthopedic Inc
Priority date: 2004-01-28
Filing date: 2005-01-19
Publication date: 2010-09-15
Anticipated expiration: 2025-01-19
Also published as: AU2009201085A1; WO2005072659A2; AU2005209210A1; ES2347444T3; DE602005022409D1; AU2009201085B2; JP4818937B2; CN1972647A; AU2009201085C1; BRPI0506577A; JP2007519475A; ATE474528T1; EP1715818A2; AU2005209210B2; US20040162616A1; US20070032872A1; EP1715818B1; KR20060123604A; CA2553532A1; WO2005072659A3

Abstract

Techniques and systems for distracting a spinal disc space and supporting adjacent vertebrae are provided. Trial instruments are insertable into the disc space to determine a desired disc space height and to select a corresponding implant. Implants can be also be self-distracting and the implant providing the desired disc space height can be implanted in the spinal disc space.

Description

Recover and keep the system and the technology of intervertebral anatomy

Related application

The application is the U.S. Patent application No.10/274 that submitted on October 21st, 2002,856 part continuation application, and the paper quoted in its entirety by reference.

Background technology

People have designed various surgical instrumenties and method and have been used for device is transplanted in the disk space between the adjacent vertebrae of spinal column.For example, spinal fusion operation can require to open continuously with before inserting disk space in relation side by side a pair of fusing device, recovers the height of disk space.In order to transplant these devices, insert at device and to wait the position passed through in disk space, to make initial one or more openings.In a position at device position, one first speculum is inserted in the disk space.In another position at device position, second a bigger speculum is inserted in the disk space.Continue one after the other to open at alternative disk space position, till reaching desired disc space height.Then, remove almost last speculum of inserting.Disk space has been ready to insert a fusing device in the position that the speculum of being withdrawn from had before occupied, simultaneously, another speculum keeps the height of the disk space of recovery.

In another technology, enter into the spinal disc space and open so that insert a graft.By applying the power of opening and come that holding tray is spatial opens to being bonded on each side of disk space the bone screw in the vertebra.

Although above operation can be effectively for some technology, also exist many shortcomings.For example, tissue, vascular and neural incision and recall the speculum that need hold in the paired insertion disk space, or hold outside speculum.Alternately continuous mutually opening can be very time-consuming, and need many steps to finish the operation of surgery.The joint of bone screw and spine and the expansion that the bone screw that engages is applied also require interpolation time and step in surgical operation.

Still need the apparatus and the technology that are used for recovering and keeping spinal disc space dissection art, it can reduce the incision of tissue, vascular and nerve as much as possible and recall.Need the apparatus and the technology that are used for recovering and keeping spinal disc space dissection art in addition, it can reduce the step and the complexity of operation as much as possible in surgical procedures.

Summary of the invention

Graft is provided, and they can one after the other insert in the spinal disc space and from wherein withdrawing from, and disk space being returned to the disc space height of expectation, and keep desired spinal disc spatial altitude after surgery when a selected graft is stayed in the spinal disc space.

Provide various apparatuses to be used for determining desired spinal disc spatial altitude, and selected one graft that desired disc space height can be provided in being inserted into the flat disk space that collapses the time.

Graft is provided, and they can have the leading edge part-structure of some test apparatus at least of identical height and battery of tests apparatus.Each test apparatus of this group has a test body, and it provides the disc space height and a leading edge part-structure of recovery, so that disk space is opened up into the disc space height of recovery.

Graft is provided, and they have from open leading edge structure.

The apparatus that is used for inserting graft also is provided.

From following description, will be appreciated that related aspects, form and embodiment.

Description of drawings

Figure 1A and 1B insert before the test apparatus and the side view from opening test apparatus and a pair of adjacent vertebra afterwards.

Fig. 2 A and 2B insert before the graft and the side view that opens graft and pair of spinal certainly afterwards.

Fig. 3 A and 3B be insert before the test apparatus and another embodiment afterwards from the distal portions of opening test apparatus and the side view of a pair of adjacent vertebra.

Fig. 4 A and 4B insert before the graft and the side view that opens graft and a pair of adjacent vertebra certainly of another embodiment afterwards.

Fig. 5 illustrates the battery of tests apparatus.

Fig. 6 illustrates one group of graft and prosthesis inserter tool.

Fig. 7 is the graft of another embodiment and the axonometric chart of prosthesis inserter tool.

Fig. 8 is the axonometric chart of the embodiment of Fig. 7 graft.

Fig. 9 is the axonometric chart of the decomposition of Fig. 8 graft.

Figure 10 A is the side view of a near-end that is coupled to the graft of the Fig. 7 that inserts apparatus.

Figure 10 B is the side view of one near-end of the graft of Fig. 7 of disengagement connection from insert apparatus.

Figure 11 A and 11B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 12 A and 12B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 13 A and 13B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 14 A and 14B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 15 A and 15B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 16 A and 16B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 17 A and 17B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 18 A and 18B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 19 A and 19B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 20 A and 20B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 21 A and 21B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 22 A and 22B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 23 A and 23B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 24 A and 24B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 25 A and 25B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 26 A and 26B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 27 A and 27B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 28 A and 28B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 29 A and 29B are respectively the plane graph and the side views of another embodiment distal portions of testing apparatus.

Figure 30 is the side view of another embodiment graft.

Figure 31 is the end-view of the graft of Figure 30.

Figure 32 is the sectional view by the line 32-32 of Figure 30.

Figure 33 is the enlarged drawing of the graft part of Figure 30.

Figure 34 is the axonometric chart of another embodiment graft.

Figure 35 is the axonometric chart of another embodiment graft.

Figure 36 is the axonometric chart that another embodiment inserts apparatus.

Figure 37 is the enlarged drawing that Figure 36 inserts the far-end of apparatus.

Figure 38 is the view of the far-end of the insertion apparatus that engages with the tail end of a graft.

Figure 39 is the axonometric chart that another embodiment inserts apparatus.

The specific embodiment

For the ease of understanding the principle of the invention, existing embodiment shown in reference to the accompanying drawings, and use specific language to describe them.However, it is to be understood that, have no intent to thus limit the scope of the invention.For the technical staff in the technical field involved in the present invention, anyly in the shown device substitute and further revise, and as any further application to the principle of the invention shown in herein, all should think can normal occurrence.

Provide the whole bag of tricks, technology, apparatus and graft to recover and/or keep a spinal disc space that collapses flat reach one the expectation disc space height.In the technology that apparatus and graft can be used for using mis instruments and technology to enter disk space.Entering the flat disk space that collapses can be single inlet, two inlet, or multiple entry.Apparatus and graft also can be used for the surgical operation of opening type, wherein, dissect and regain skin and tissue, thereby enter in the spinal disc space that collapses flat.Described method, technology, apparatus and graft also can be used for any surgical operation and are close to spine, comprise edgewise, preceding-edgewise, back-edgewise, back to and forward direction approaching.Moreover surgical method, technology, apparatus and graft can partly be located to be applied at all vertebras of spine, comprise the zone of lumbar vertebra, thoracic vertebra and cervical vertebra.

Referring now to Figure 1A, a graft shown in figure test apparatus 20, it has a proximal handle 22, from the axle 24 of handle 22 towards remote extension, and a test body 26.Test body 26 comprises that one is connected or integrally formed near-end 28 with spools 24 far-end, and a leading insertion end 30.Test body 26 also comprises a upper surface 26a and an opposing lower surface 26b.The test body has a height H 1 between upper surface 26a and lower surface 26b.Near-end 28 can be tapered or alternate manner construct, so that gradually a transition to be provided, be convenient to from the spinal disc space, withdraw from test body 26 between surperficial 26a, 26b.

Test apparatus 20 can be inserted in the disk space D that one between adjacent vertebra V1 and the V2 collapse flat.Leading edge part 30 can be provided with the nose shape shape of a rounding, and its allows at least a portion of leading edge part 30 can be inserted into one to collapse in the flat not open disk space D.When test body 26 advanced in the disk space D, the edge of spine V1 and V2 depended on respectively up and down along the nose shape part of the rounding of leading edge part 30.In case leading edge part 30 is fully inserted, the disk space D that collapses flat is opened to recover disk space D ' (shown in Figure 1B).The disk space D ' that recovers has the height between the end plate of adjacent vertebra V1, V2, and it is corresponding to the height H 1 of the test body 26 between upper surface 26a and the lower surface 26b.

Test body 26 is inserted in the disk space D, and the surgeon can determine by the test apparatus in sense of touch and the macroscopy disk space whether disk space D has sufficiently opened or navigated to the disc space height of an expectation.For example,, or do not provide a cooperation of fitting, then test apparatus 20 and can withdraw from, and second a test apparatus with test body of high height H1 inserts if test apparatus 20 easily moves.Perhaps, if the cooperation of test body 26 is too tight or mismatch, then it can be withdrawn from and another test apparatus that will have a test body of less height H 1 inserts in disk space D.Provide one to be noted by the surgeon, so that select a graft corresponding to the specific test apparatus 20 of the disc space height of the recovery of expectation disc space height.

In Fig. 2 A, a graft 40 with a body 42 shown in the figure.Body 42 comprises a near-end 44 and a leading insertion end 46.Selected graft is dimensionally with in shape corresponding to test body 26, and this test body provides the disc space height of desired cooperation and requirement to the disk space D that collapses flat.In case graft 40 is selected, test body 26 is withdrawn from from the disk space D ' that recovers, and the disk space D ' of recovery collapses flat at least in part.Graft 40 has a leading edge part 46, and its size and dimension is identical with the size and dimension of test body, and graft 40 will be inserted in the disk space D that collapses flat, because test body 26 once inserted in this disk space D that collapses flat.Shown in Fig. 2 B, the disk space D that recovers also to collapse this flat after surgery at graft between spine V1 and the V2 40 remains on the disc space height H1 who requires.

With reference to Fig. 3 A, the test apparatus 20 ' of an alternate embodiment shown in the figure.Test apparatus 20 ' can comprise a proximal handle (not shown), one from handle towards the axle 24 ' that distally extends, an and test body 26 '.Test body 26 ' comprises that one is connected or integrally formed near-end 28 ' with spool 24 ' far-end, and a leading insertion end 30 '.Test body 26 ' also comprises a upper surface 26a ' and an opposing lower surface 26b '.The test body has a height H 1 between upper surface 26a ' and lower surface 26b '.Near-end 28 ' can be tapered or alternate manner construct, so that gradually a transition to be provided, be convenient to from the spinal disc space, withdraw from test body 26 ' between surperficial 26a ', 26b '.

Test apparatus 20 ' can be inserted in the disk space D that one between adjacent vertebra V1 and the V2 collapse flat.Compare with leading edge part 30, leading edge part 30 ' can be provided with the conical nose shape part of a tool offensive, and the leading edge part 30 ' that leading edge part 30 overlaps among Fig. 3 A goes up to make comparisons.Leading edge part 30 ' can have a sharp-pointed or blunt end nose 30a '.Nose 30a ' in height can be less relatively, so that insert in the disk space D who seriously collapses flat.For example, the height of nose 30a ' can be at 3 millimeters or less than to about 5 or 6 millimeters scope.Leading edge part 30 ' also comprises on one transitional surface 30b ' and transitional surface 30c ' once.Transitional surface 30b ', 30c ' extend to corresponding upper surface 26a ' and lower surface 26b ' from nose 30a '.Transitional surface 30b ', 30c ' provide a smooth and transition gradually, so that advance when entering into the disk space D that collapses flat in spine V1 and V2 that separation is collapsed flat at test body 26 '.Shown in Fig. 3 B, in case leading edge part 30 ' is fully inserted, the disk space D that collapses flat is opened or recovers by body 26 '.Spine V1 ' and V2 ' can be separated into height H 1, so that the disk space D ' of recovery to be provided, the disk space D ' that recovers has the height between the end plate of adjacent vertebra, and it is corresponding to the height H 1 of the test body 26 ' between upper surface 26a ' and the lower surface 26b '.

In Fig. 4 A, a graft 40 ' with a body 42 ' shown in the figure.Body 42 ' comprises a near-end 44 ' and a leading insertion end 46 '.Body 42 ' also comprises a upper surface 42a ' and an opposing lower surface 42b '.Body 42 ' has a height H 1 between surperficial 42a ' and 42b '.The size and dimension of leading insertion end 46 ' is identical with the leading edge part 30 ' of test body 26 '.Height H 1 between surperficial 42a ', the 42b ' of graft body 42 ' has the height H 1 between surperficial 26a ', the 26b ' of test body 26 '.

Leading insertion end 46 ' can be provided with the nose of the taper of a tool offensive, such as the nose of the leading insertion end 30 ' that is provided with test apparatus 20 '.Leading edge part 46 ' can have a sharp-pointed or blunt nose 46a '.Nose 46a ' in height can be less relatively, so that insert in the disk space D who seriously collapses flat.For example, the height of nose 46a ' can be at 3 millimeters or less than to about 5 or 6 millimeters scope.Leading edge part 46 ' also comprises on one transitional surface 46b ' and transitional surface 46c ' once.Transitional surface 46b ', 46c ' extend to corresponding upper surface 42a ' and lower surface 42b ' from nose 46a '.Transitional surface 46b ', 46c ' provide a smooth and transition gradually, so that advance when entering in the disk space D that collapses flat at graft body 42 ', separate spine V1 and the V2 that collapses flat.Leading edge part 46 ' is fully inserted to recover the disk space D that collapses flat.Shown in Fig. 4 B, the disk space D ' that is opened or recover between spine V1 ' and the V2 ' has the height between the end plate of adjacent vertebra V1 ', V2 ', and it is corresponding to the height H 1 of the graft body 42 ' between upper surface 42a ' and the lower surface 42b '.

In use, graft 40 ' can be from having similar structures but is selected one group of graft of differing heights H1.Graft 40 ' may be selected to be in height corresponding to test body 26 ', and this test body 26 ' provides the disc space height of the cooperation and the expectation of expectation to the disk space D that collapses flat.In case graft 40 ' is chosen, the test body 26 ' of Cha Ruing is withdrawn from from the disk space D ' that recovers at last, so the disk space D ' of recovery collapses flat.Yet, because the leading edge part 46 ' of graft 40 ' is identical with the leading edge part 30 ' of test body 26 ', and the last test body 26 ' that inserts once inserted in the disk space D of over recovery, so selected graft 40 ' will also can insert in the disk space D that collapses flat.Graft 40 ' therefore provides a disk space D ' who recovers, it is corresponding to the disc space height by the indicated expectation of test body 26 ', and selected and the graft 40 ' that inserts can remain on the disk space D ' that recovers the disc space height H1 of an expectation after surgery.

In the embodiment of Figure 1A-4B, can consider that graft 40,40 ' is attached on the far-end of axle 24, so that can be inserted in the disk space D that collapses flat releasedly.It is also conceivable that, do not provide independent test apparatus, a series of graft 40,40 ' can be provided with the height H 1 of increase.The surgeon can insert, and if necessary, and can withdraw from various graft 40,40 ' and provides the disc space height of expectation with in the graft of determining various height that.Provide the graft of expectation disc space height to stay in the disk space, so that keep the disc space height of expectation after surgery.By providing so from open graft, it has not been required to be inserts and opens the flat disk space that collapses in advance, then can further reduce step number and needed time of surgical operation in the surgical operation.Yet, can not keep out the graft that ballistic other material is made for time in the flat disk space that collapses by certain type of bone material or insertion, the apparatus that test is provided then is favourable, because the test apparatus provides a kind of indication, indicate graft be hit and before entering in the disk space graft can cooperate, in withdrawing from process or insertion process, reduced to damage the probability of graft thus.

Can also conceive in one group of graft that graft 40 ' can be arranged on the height H 1 with increase.The height that leading edge part 46 ' is located can be identical for each graft 40 ' of this group, and like this, when graft initially entered, any graft of this group can chosenly be inserted in the flat disk space that collapses.Can one after the other expand with graft 40 ', if perhaps the first selected graft provides needed disc space height and cooperation, then expansion can minimize.For example, the graft 40 ' of the various height of this group respectively can comprise transitional surface 46b ', 46c ', and they present taper from the nose 46a ' that is arranged on the equal height on each graft to the differing heights H1 the upper and lower surperficial 42a ', the 42b ' that are arranged on each graft.

In Fig. 5, has a test apparatus group 50 of a plurality of

test apparatuses

52,54,56,58,60,62,64,66,68 and 70 shown in the figure.Test apparatus 52 comprises one handle 52a, from the axle 52b of handle 52a towards remote extension, and a test body 52c.Other each test apparatus also comprises one handle, one and a test body.Each test body that can consider to test apparatus provides the differing heights between upper and lower contact surface, so that recover the flat disk space that collapses.For example, test apparatus 52 can be provided with a test body, and it has the minimum constructive height H of this apparatus group 50, and test apparatus 70 can be provided with a test body, and it has the maximum height H ' of this apparatus group 50.Remaining test apparatus can provide the test apparatus of a plurality of differing heights of altitude range between H and H '.In a special embodiment of apparatus group 50, the height of the test apparatus in this group is with 1 millimeter stepping.In another special embodiment, altitude range is from 6 millimeters to 15 millimeters, and with 1 millimeter stepping.Also can consider other stepping and other altitude range.

In Fig. 6, a group 80 of the tool of prosthesis inserter shown in the figure 82,84,86.Prosthesis inserter tool 82 comprises one handle 82a, a 82b, and a graft 82c who is releasably connected to a 82b far-end.Graft 82c has a height H between its upper and lower spine contact surface

Prosthesis inserter tool 84 comprises one handle 84a, a 84b, and a graft 84c who is releasably connected to a 84b far-end.Graft 84c can have a height H between its upper and lower spine contact surface ".Prosthesis inserter tool 86 comprises one handle 86a, a 86b, and a graft 86c who is releasably connected to a 86b far-end.Graft 86c can have a height H between its upper and lower spine contact surface '.Also as shown in Figure 6, each

graft

82c, 84c, 86c can insert the apparatus from it and discharge, like this, any one among

graft

82c, 84c, the 86c can selected insertion and the postoperative operation be implanted in the disk space.

Prosthesis inserter tool group 80 can be conceived and test apparatus group 50 can be provided with.Each these grafts can be preloaded on the apparatus axis, so that save time in surgical procedures.Yet each these grafts also can be provided with single apparatus axis separately, and then, when the graft height of expectation was determined, suitable graft was coupled on the apparatus axis.The height H of

graft

82c, 84c, 86c

, H " and H ' correspond respectively to the height H of

test apparatus

66,68 and 70 test body

, H " and H '.Therefore, by alternately the optional test body being inserted in the disk space, but that test body has the height that desirably is engaged in the disk space is provided in surgeon's confirmed

test apparatus

66,68 and 70.Remove the test body that the expectation disc space height is provided, and select to provide a prosthesis inserter tool with graft of equal height, graft is inserted in the disk space to recover and to keep the disc space height of expectation.

Three above

prosthesis inserter tools

82,84,86 can be conceived and prosthesis inserter tool group 80 can be provided with.For example, one group of prosthesis inserter tool can be provided with a plurality of grafts, and a height that respectively has is corresponding to the height of a test body of test apparatus 50.Also can conceive, not provide any test apparatus group 50, one prosthesis inserter tool groups 80 can be provided with a plurality of grafts that the Desired Height scope is provided.The graft of prosthesis inserter tool group one after the other inserts, and if necessary, withdraws from from the flat disk space that collapses.Provide expectation to cooperate and the graft of expectation disc space height is stayed in the disk space with the spatial height of holding tray after surgery.

In Fig. 7, a graft 110 that is connected with the far-end that inserts apparatus 90 shown in the figure.Insert apparatus 90 and comprise a proximal shaft 92 and a proximal cap 94.One intermediary hub 96 is positioned at the far-end of proximal shaft 92.One bounces other apparatus of hammering into shape or helping graft 110 slapping against in the disk space can fix around proximal shaft 92, and bounces against end cap 94 and/or hub 96.

Is one to comprise the actuator of first member 98 and one second member 100 from hub 96 towards remote extension.First member 98 comprises that at its far-end a junction divides 108, and second member 100 comprises that at its far-end a junction divides 104.First and second members 98,100 are connected pin 106 places pivotly, so that at least one Wei Rao the pin 106 in the coupling part 104,108 moves with respect to another coupling part.In an illustrated embodiment, by along the direction moving handle 102 of arrow P 2 to engage and to discharge graft 110 between the connecting elements 104,108, the direction of coupling part 104 around pin 106 along arrow P 1 moved.

In one embodiment, graft 110 comprises two or polylith material, and they can temporarily or for good and all link together, and in can the process in being inserted into disk space, keeps together by inserting apparatus 90.Graft 110 comprise one from open leading edge part 116 so that be inserted into one and collapse in the flat disk space.In another embodiment, graft 110 comprises one single material.The material that comprises graft 110 can be solid, porous, many boring, punching, open wide and/or sponge.

The details of one embodiment of relevant graft 110 is shown among Fig. 8.Graft 110 comprises a body 112, and it has a upper surface 114 and an opposing lower surface 117.Upper and lower surperficial 114,117 can be provided with groove, depression, ridge, sawtooth, annular knurl, railway spike, rough surface, or smooth surface, so that engage the end plate of adjacent vertebra.Body 112 comprises the leading edge part 116 of a circle or taper configurations, and like this, when body is inserted into one when collapsing in the flat disk space, body 112 opens adjacent spine.Body 112 also comprises a proximal end wall 111, and the sidewall 113,115 that extends between proximal end wall 111 and leading edge part 116.Shown in Figure 10 A and 10B, the second groove 124b in first groove 124a in the sidewall 113 and the sidewall 115 respectively opens wide towards remote extension and at proximal end wall 111 from proximal end wall 111.The first groove 124a can be provided with a depression 126a, and the second groove 124b can be provided with a depression 126b.

In Fig. 9, graft 112 is shown as an exploded view.Body 112 can be arranged in one first side direction part 112a and the one second side direction part 112b.

Side direction part

112a, 112b respectively comprise upper surface 114a, 114b, lower surface, and the counterpart of leading edge part 116a, 116b.Side direction part such as side direction part 112a can be provided with a boring 120, sells 118 such as the opposite side of side direction part 112b to partly being provided with one.Pin 118 is inserted in the boring 120, so that

side direction part

112a, 112b are fixed to one another.Side direction part 112a comprises an intermediary surperficial 122a, and side direction part 112b comprises an intermediate surface 122b.When

side direction part

112a, 112b assembled,

intermediate surface

122a, 122b were contiguous mutually positioning.

Intermediate surface

122a, 122b can respectively be provided with Feng Hegu, and they are alternate with the Feng Hegu of another intermediate surface to engage mixedly, with help

side direction part

112a, 112b keeps together and prevent therebetween relative motion.In the embodiment shown, peak and paddy are extended along the direction between upper surface 114 and the lower surface 117.Also can consider other orientation for Feng Hegu, for example, between leading end parts 116 and near-end 111, extend, or extend diagonally.

In the embodiment of above-mentioned graft 110, can conceive graft 110 and be made by cortical bone, its longitudinal axis that cuts into the side direction part 112a, the 112b that make between

leading edge part

116a, 116b and the near-end 111 is parallel to the longitudinal axis of the main bone that downcuts all parts.Longitudinally obtain the graft part by main bone cutting, the leading edge part 116 of graft 110 be provided with maximum intensity and ruggedness with opposing to inserting the impact of the graft 110 in the disk space.The embodiment of other of graft 110 considers that graft 110 is set to the unit of one, and can be made by single bone material, or is made by the material of non-bone.

Shown in Figure 10 A and 10B, coupling part 104,108 is positioned in groove 124a, the 124b, inserts apparatus 90 so that graft 110 is joined to.Coupling part 104 can comprise that one is positioned at depression outstanding 105 in the 126b, and coupling part 108 can comprise that one is positioned at outstanding 109 in the depression 126a.In Figure 10 A, the width W 2 that coupling part 104,108 forms between the edgewise outward flange, it is less than the width W 1 between graft 110 sidewalls 113,115.Therefore, coupling part 104,108 and insertion apparatus 90 are laterally outstanding from graft 110 during insertion.Shown in Figure 10 B, move away from each other coupling part 104,108, to be separated from graft 110 and to remove from depression 126b, 126a respectively and give prominence to 105,109, like this, inserts apparatus 90 and can longitudinally withdraw from from graft 110.Width between the side direction outward flange of coupling part 104,108 can be limited in the position of disengagement, with the width W 1 that is equal to or less than graft 110.Like this, insert apparatus 90 and can throw off, keep a low profile simultaneously, its not outstanding or laterally outstanding sidewall 113,115 that surpasses with graft 110.Its result, graft 110 navigates to the path that flat disk space passed through that collapses only need be large enough to hold graft 110.

Referring now to Figure 11 A-11B, be attachable to an embodiment of distal portions 140 that inserts the test apparatus of apparatus shown in the figure.The distal portions that is used for testing other embodiment of apparatus is presented at Figure 12 A-12B, and they are similar to the distal portions of Figure 11 A, but has different geometrical properties for the disc space height of determining an expectation.Yet, as hereinafter discussing, the distal portions of Figure 12 A-20B has the geometrical property that is different from distal portions 140, and a group far end part 140 is provided, they can one after the other insert and withdraw from from the spinal disc space that collapses flat, insert wherein to determine a suitable graft.In addition, can conceive provides graft, makes each test body of the far-end 140 shown in Figure 11 A-20B have identical size and dimension.

Distal portions 140 comprises a test body 142 and an axle coupling part 144 of extending from test body 142 near-end ground.Axle coupling part 144 can be connected to one and insert apparatus.Other embodiment considers to test body 142 and forms with the insertion apparatus.Test body 142 and insert the syndeton of conceiving between the apparatus comprise clamp connect, friction connects, hold-down screw connects, be threaded, buckle connects, and ball-depression connection.Test body 142 comprises a upper surface 142a and a lower surface 142b, so that the end plate of contact adjacent vertebra.Test body 142 also comprises lateral surface 142c and 142d.The side direction transitional surface of circle or taper extends between lateral surface 142c, the 142d of upper and

lower surperficial

142a, 142b and correspondence.Test body 142 also comprises a leading edge part 146 and a near-end 148.Near-end 148 can be tapered, so that withdraw from test body 142 from disk space.Leading edge part 146 comprises a nose 146a and carries out the transition to the circular portion of upper and

lower surperficial

142a, 142b.

Distal portions 140 comprises a total length L 1, and test body 142 comprises a length L 2.Upper and

lower surperficial

142a, 142b can be curved along radius R 2, so as generally with the vertebral endplate geometric match.The upper and lower transitional surface of leading edge part 146 can be curved along radius R 2 '.Test body 142 comprises a maximum total height H2 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b can be curved and be provided a height H 2 ' at leading edge 146 places.Height H 2 ' is less than height H 2, so that leading edge part 146 is inserted in the disk space of spine.Test body 142 can be provided with an overall width W3 between

lateral surface

142c and 142d.

In Figure 12 A and 12B, distal portions 140 is provided with a body 142, and it has along radius R 3 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 3 '.Test body 142 has a maximum total height H3 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 3 ' at leading end parts 146 places.Height H 3 ' is less than height H 3, so that leading edge part 146 is inserted in the spinal disc space.

In Figure 13 A and 13B, distal portions 140 is provided with a body 142, and it has along radius R 4 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 4 '.Test body 142 has a maximum total height H4 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 4 ' at leading end parts 146 places.Height H 4 ' is less than height H 4, so that leading edge part 146 is inserted in the spinal disc space.

In Figure 14 A and 14B, distal portions 140 is provided with a body 142, and it has along radius R 5 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 5 '.Test body 142 has a maximum total height H5 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 5 ' at leading end parts 146 places.Height H 5 ' is less than height H 5, so that leading edge part 146 is inserted in the spinal disc space.

In Figure 15 A and 15B, distal portions 140 is provided with a body 142, and it has along radius R 6 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 6 '.Test body 142 has a maximum total height H6 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 6 ' at leading end parts 146 places.Height H 6 ' is less than height H 6, so that leading edge part 146 is inserted in the spinal disc space.

In Figure 16 A and 16B, distal portions 140 is provided with a body 142, and it has along radius R 7 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 7 '.Test body 142 has a maximum total height H7 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 7 ' at leading end parts 146 places.Height H 7 ' is less than height H 7, so that leading edge part 146 is inserted in the spinal disc space.

In Figure 17 A and 17B, distal portions 140 is provided with a body 142, and it has along radius R 8 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 8 '.Test body 142 has a maximum total height H8 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 8 ' at leading end parts 146 places.Height H 8 ' is less than height H 8, so that leading edge part 146 is inserted in the spinal disc space.Upper and

lower surperficial

142a, 142b are also tapered to form angle α with the central axis that inserts apparatus along near-end 148.Angle α provides a slick transition between coupling part 144 and body 142, body 142 is hung up or held on the end plate of spine when preventing that it from withdrawing from.

In Figure 18 A and 18B, distal portions 140 is provided with a body 142, and it has along radius R 9 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 9 '.Test body 142 has a maximum total height H9 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 9 ' at leading end parts 146 places.Height H 9 ' is less than height H 9, so that leading edge part 146 is inserted in the spinal disc space.Upper and

lower surperficial

142a, 142b are also tapered to form angle α with the central axis that inserts apparatus along near-end 148.

In Figure 19 A and 19B, distal portions 140 is provided with a body 142, and it has along radius R 10 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 10 '.Test body 142 has a maximum total height H10 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 10 ' at leading end parts 146 places.Height H 10 ' is less than height H 10, so that leading edge part 146 is inserted in the spinal disc space.Upper and

lower surperficial

In Figure 20 A and 20B, distal portions 140 is provided with a body 142, and it has along radius R 11 curved upper and lower surperficial 142a, 142b.The upper and lower transitional surface of leading edge part 146 is curved along radius R 11 '.Test body 142 has a maximum total height H11 between upper and lower surperficial 142a, 142b.Upper and

lower surperficial

142a, 142b is curved and provide a height H 11 ' at leading end parts 146 places.Height H 11 ' is less than height H 11, so that leading edge part 146 is inserted in the spinal disc space.Upper and

lower surperficial

Can conceive, by revising each distal portions 140 of Figure 11 A-20B, can be provided with one group from open graft, like this, between its far-end and near-end, graft has a length that is engaged in the spinal disc space.For example, axle coupling part 144 can be removed, or test body 142 can be in proximal end wall 150 truncates.The near-end of graft can comprise that one is positioned at the screwed hole of proximal end wall, the groove of lateral sidewall, or other is used for can discharging the suitable structure that engages with an insertion apparatus.

In one of the test apparatus group of the distal portions that uses Figure 11 A-20B special embodiment, each body 142 can be provided with have an appointment 10 millimeters width W 3 and about 42 millimeters length L 1.Each distal portions 140 can be provided with 60 millimeters the total length L 2 of having an appointment.Leading edge part 146 can be provided with 5 millimeters radius R between

lateral surface

142c, 142d, and angle α can be about 25 degree.

In special embodiment, the height H 2 of Figure 11 A embodiment is 6 millimeters.Each height H 3 to H11 can increase progressively with 1 millimeter class from H2 to H11.Therefore, height H 11 is 15 millimeters.In addition, partly locate highly to successively decrease at each leading edge, for example, height H 2 ' can be 4 millimeters, or 2 millimeters, less than height H 2.Similarly, each height H 3 ' to H11 ' can be 2 millimeters, less than the height H 3 of correspondence to H11.Between nose 146a and upper and

lower surperficial

142a, 142b the radius R 2 ' of transition to R5 ' can respectively be 2 millimeters.Radius R 6 ' and R7 ' can respectively be 3 millimeters, and radius R 8 ' to R11 ' can respectively be 4 millimeters.

Special embodiment also can be contemplated that: for each body 142, upper and

lower surperficial

142a, 142b have a different curvature, and with consistent with the vertebral endplate of a vicinity, this end plate is relevant with the special deployed height that is provided by special body 142.For example, radius R 2 is about 221 millimeters, radius R 3 is about 179 millimeters, and radius R 4 is about 152 millimeters, and radius R 5 is about 133 millimeters, radius R 6 is about 119 millimeters, radius R 7 is about 108 millimeters, and radius R 8 is about 100 millimeters, and radius R 9 is about 92 millimeters, radius R 10 is about 86 millimeters, and radius R 11 is about 81 millimeters.

Although the specific embodiments to a group far end part 140 provides concrete size and geometric properties, but should be understood that, such size and geometric attribute provide for a certain embodiments, and other embodiment can consider to be different from other size provided here.

With reference to Figure 21 A-21B, be attached to an embodiment of a distal portions 240 that inserts the test apparatus of apparatus shown in the figure.The distal portions 240 that is used for testing other embodiment of apparatus is shown in Figure 22 A-29B, and they are similar to the distal portions of Figure 21 A, but has different geometrical properties for the disc space height of determining an expectation.Yet, as hereinafter further discussing, the distal portions of Figure 22 A-29B has the geometrical property that is different from distal portions 240, and a group far end part 240 is provided, they can one after the other insert and withdraw from from the spinal disc space that collapses flat to determine a suitable graft, so that insert wherein.In addition, can consider to provide graft, they have each the advance copy bulk phase size and dimension together with the distal portions 240 shown in Figure 21 A-29B.

Distal portions 240 comprise one the test body 242 and therefrom towards proximal extension the axle coupling part 244.Axle coupling part 244 can be connected to one and insert apparatus.Other embodiment considers to test body 242 and forms with the insertion apparatus.Conceived between test body 242 and insert coupling structure between the apparatus include clamp connect, friction connects, hold-down screw connects, be threaded, buckle connects, and ball-depression connection.Test body 242 comprises a upper surface 242a and a lower surface 242b that is used for contacting adjacent vertebral endplate.Test body 242 also comprises lateral surface 242c and 242d.The side direction transitional surface of circle or taper extends between lateral surface 242c, the 242d of upper and

lower surperficial

242a, 242b and correspondence.Test body 242 also comprises a leading edge part 246 and a near-end 248.Near-end 248 can be tapered so that withdraw from test body 242 in disk space.Leading edge part 246 comprises a nose 246a flat or slightly circular and upper and lower

transitional surface

246b, 246c from wherein extending.Upper and lower

transitional surface

246b, 246c provide a deployed height that increases gradually of extending from nose 246a, so that the opening of adjacent vertebra.

Distal portions 240 comprises a total length L 1, and test body 242 comprises a length L 2.Upper and

lower surperficial

242a, 242b can be curved along a radius R3, so that generally mate with the geometry of vertebral endplate.Upper and lower transitional surface 246b, the 246c of leading edge part 246 can be along tapered with respect to the angle A 1 of a central axis that longitudinally extends through body 242.Test body 242 comprises a maximum total height H3 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 3 at nose 246a place.One radius R12 can provide a slick transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 3, so that leading edge part 246 is inserted in the spinal disc space.Test body 242 can be provided with an overall width W3 between

lateral surface

242c and 242d.

In Figure 22 A and 22B, distal portions 240 is provided with a body 242, and it has along radius R 4 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 1 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H4 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 4 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 4, so that leading edge part 246 is inserted in the spinal disc space.

In Figure 23 A and 23B, distal portions 240 is provided with a body 242, and it has along radius R 5 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 2 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H5 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 5 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 5, so that leading edge part 246 is inserted in the spinal disc space.

In Figure 24 A and 24B, distal portions 240 is provided with a body 242, and it has along radius R 6 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 2 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H6 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 6 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 6, so that leading edge part 246 is inserted in the spinal disc space.

In Figure 25 A and 25B, distal portions 240 is provided with a body 242, and it has along radius R 7 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 3 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H7 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 7 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 7, so that leading edge part 246 is inserted in the spinal disc space.

In Figure 26 A and 26B, distal portions 240 is provided with a body 242, and it has along radius R 8 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 4 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H8 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 8 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 8, so that leading edge part 246 is inserted in the spinal disc space.Upper and

lower surperficial

242a, 242b are also tapered along near-end 248, to form the angle that becomes α with the central axis that inserts apparatus, thereby between coupling part 244 and body 242, provide a slick transition, to prevent that when withdrawing from body 242 is stranded or to hold on vertebral endplate.

In Figure 27 A and 27B, distal portions 240 is provided with a body 242, and it has along radius R 9 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 4 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H9 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 9 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 9, so that leading edge part 246 is inserted in the spinal disc space.Upper and

lower surperficial

In Figure 28 A and 28B, distal portions 240 is provided with a body 242, and it has along radius R 10 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 4 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H10 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 10 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 10, so that leading edge part 246 is inserted in the spinal disc space.Upper and

lower surperficial

242a, 242b are also tapered along near-end 248, to form the angle that becomes α with the central axis that inserts apparatus.

In Figure 29 A and 29B, distal portions 240 is provided with a body 242, and it has along radius R 11 curved upper and lower surperficial 242a, 242b.Upper and lower transitional surface 246b, the 246c edge of leading edge part 246 can be tapered with respect to the angle A 5 of the central axis C that longitudinally extends through body 242.Test body 242 comprises a maximum total height H11 between upper and lower surperficial 242a, 242b.Upper and

lower surperficial

242a, 242b are tapered to height H12 from height H 11 at nose 246a place.Radius R 12 can provide a smooth transition between

transitional surface

246b, 246c and nose 246a.Height H 12 is less than height H 11, so that leading edge part 246 is inserted in the spinal disc space.Upper and

lower surperficial

Can conceive one group from open graft, provide this from open graft by each distal portions 240 of revising Figure 21 A-29B, like this, between its far-end and near-end, graft has a length that is engaged in the spinal disc space.For example, removable axle coupling part 244, or test body 242 can be in proximal end wall 250 a places butt.The near-end of graft can comprise that one is positioned at the screwed hole of proximal end wall, the groove of lateral sidewall, or inserts the structure that apparatus engages with one releasedly.

In one of the test apparatus group of the distal portions that uses Figure 21 A-29B special embodiment, each body 242 can be provided with have an appointment 10 millimeters width W 3 and about 42 millimeters length L 1.Each distal portions 240 can be provided with 60 millimeters the total length L 2 of having an appointment.Leading edge part 246 can be provided with a radius R of 5 millimeters between

lateral surface

242c, 242d.

In special embodiment, the height H 3 of Figure 21 A embodiment is 7 millimeters.Each height H 4 to H1 1 increases progressively from height H 3 to height H11 with 1 millimeter stepping.Therefore, height H 11 is 15 millimeters.For each body 242, height H 12 is 3 millimeters at nose 246a place.The radius R 12 of transition can be about 1.5 millimeters between nose 246a and upper and lower transitional surface 246b, the 246c.

Transitional surface

246b, 246c extend between radius R 12 and adjacent upper and lower surperficial 242a, 242b.For shown in each embodiment,

transitional surface

246b, 246c can be within the scopes of angle A1 to A5 with respect to the angle orientation of body 242 central axis.In one of test apparatus group special embodiment, angle A 1 about 15 degree, angle A 2 about 20 degree, angle A 3 about 25 degree, angle A 4 about 30 degree, angle A 5 about 35 degree.Specific embodiment can be contemplated that also upper and

lower surperficial

242a, 242b are provided with different curvature to each body 242.For example, radius R 3 can be about 179 millimeters, radius R 4 can be about 152 millimeters, radius R 5 can be about 133 millimeters, and radius R 6 can be about 119 millimeters, and radius R 7 can be about 108 millimeters, radius R 8 can be about 100 millimeters, radius R 9 can be about 92 millimeters, and radius R 10 can be about 86 millimeters, and radius R 11 can be about 81 millimeters.

Although the specific embodiments to a group far end part 240 provides concrete size and geometric properties, but should be understood that, such size and geometric attribute provide for a certain embodiments, and other embodiment can consider to be different from other size provided here.

Referring now to Figure 30-33, the graft 310 of another embodiment shown in the figure.Graft 310 comprises one from open leading edge part 316, collapses in the flat disk space so that insert one.Graft 310 can be made up of aforesaid single block of material or polylith material.U.S. Patent Application Serial No.10/669,779 provide other example of the graft of assembling, and the full content that this paper quotes this patent is for your guidance.The material that comprises graft 310 can be solid, porous, many boring, punching, open wide and/or sponge.Graft 310 can be by one or polylith bone material, non-bone material, or their combination and making.

Graft 310 comprises a body 312, and it extends between a leading edge part 316 and an end section 311 along a longitudinal axis 319.Sidewall 313,315 extends between a leading edge part 316 and an end section 311 along axis 319.Body 312 comprises a upper surface 314 and an opposing lower surface 317.Upper and lower surperficial 314,317 can be provided with engagement member 334, and they can comprise following any one or their combination: groove, depression, ridge, sawtooth, annular knurl, railway spike, or be used to engage the rough surface of adjacent vertebral endplate.Leading edge part 316 can comprise a circle or pyramidal structure, so that body 312 is provided with a leading edge nose, this nose is inserted into the adjacent spine of an expansible when collapsing in the flat disk space when it.Body 312 also comprises the tail end wall 321 of a near-end, and the sidewall 313,315 that extends between proximal end wall 321 and leading edge part 316.Second groove 326 in first groove 324 in the lateral sidewall 313 and the lateral sidewall 315 opens wide towards near-end at proximal end wall 321 places, and in remote extension arrives end section 311.

Proximal end wall 321 comprises that one is formed on hole 328 wherein so that with a tool engagement of inserting.This hole 328 can be a circular port, can be screwed hole so that engage with a threaded stud of inserting apparatus.Hole 328 comprises an open flared opening 330, is placed in the hole 328 so that will insert apparatus.Other embodiment considers that hole 328 can be slick and threadless.Also have other embodiment to consider that hole 328 is non-circular.Consider that in addition graft 310 does not have hole 328, or have a plurality of holes 328.

Graft 310 comprises an inner chamber 332 that extends and open between upper surface 314 and lower surface 317.Inner chamber 332 is surrounded by sidewall 313,315, leading edge part 316 and end section 311.Sidewall 313,315 comprises hole 318,320 respectively, and they extend through wherein and are communicated with inner chamber 332.Hole 318,320 comprises that one is round-shaped, but also can consider the hole of other shape and quantity in sidewall 313,315.Inner chamber 332 comprise an ellipse or runway shape (when from shown in figure 32 one of upper and lower surperficial 314,317 when observing).The inner wall surface of sidewall 313,315 extends parallel to each other, the inner wall surface rounding of leading edge part 316 and end section 311, and between the inner surface of sidewall 313,315, extend.

Engagement member 334,344 extends along sidewall 313,315, and gives prominence to from upper and lower surperficial 314,317 of correspondence.Engagement member 334,344 extends along the part of sidewall 313,315, and sidewall 313,315 extends along inner chamber 332.Upper and lower surperficial 314,317 comprise a profile along the smooth surface of leading edge part 316 and end section 311.Therefore, composition surface 334,344 is best along the arcual upper and lower graft surface location of convexity, so as with the vertebral endplate center near engages than cartilage material, to resist the dismounting of graft 310.Moreover the profile of the smooth surface at leading edge and tail end place makes the load-bearing surface area maximum of graft 310, and this graft 310 is positioned at upper and lower surperficial 314,317 the part place than the os osseum material that is adjacent to the limbus corticalis place.This has improved open maintenance, and in graft 310 is positioned at the spinal disc space time for the fixed resistance of postoperative of contiguous spine.

In a certain form, engagement member 334,344 is positioned at the front of tooth, and comprises the leading end wall 316 of a gradient, the tail end wall 338 of an approximate vertical, and a transitional surface 340 (as shown in figure 33) that extends betwixt.One groove or cave in 342 extends between contiguous tooth.Tooth is from upper and lower surperficial 314,317 outstanding distances 350 of correspondence.In a certain form, upper and lower surperficial 314,317 extend along an arc that is formed by radius 350, and composition surface 334,344 makes radius 352 greater than radius 350 along an arc extension that is formed by radius 352.Adjacent teeth is separated by spacing 354, and this spacing records between contiguous tail end wall 338.Keep orthogonal directed in order to make along all teeth of the arc spacing that is formed by radius 350, tail end wall 338 is oriented and is oriented relative to one another to angle 356.Tail end wall 338 is perpendicular to the arc that is formed by radius 350, and leading end wall 336 forms one jiao 358 with tail end wall 338.In a special embodiment, radius 352 is bigger 1 millimeter than radius 350, and spacing 354 is 3 millimeters.Angle 358 can be spent to the scopes of 90 degree 0 in one embodiment, and in another embodiment, angle 358 can be at 30 degree to the scopes of 80 degree; In also having another embodiment, angle 358 is 65 degree.However, it is to be understood that, can conceive other radius, spacing and angle.

Graft 310 can be arranged in the cover group with a plurality of grafts, and all grafts have various height and/or length, can select from the cover group surgical procedures Chinese and foreign department doctor, is engaged in the spinal disc space with the graft that expectation is provided.Can conceive each graft and be provided with a width 360.In a certain form, this width 360 all is identical for each graft in the cover group.In another form, each graft 310 comprises a leading edge nose, and this nose comprises one towards the circle of distal orientation or the leading edge profile of rounding so that be inserted into one non-open or the disk space of local opening in.In also having another embodiment, a plurality of grafts 310 are arranged in the cover group with a plurality of speculumes, and all speculum comprises one, this head on size and dimension corresponding to graft 310 accordingly.As mentioned above, speculum can comprise one, and it is attached to one integratedly and goes up or removably be attached on one.

Can also conceive graft 310 and comprise inner chamber 332, this inner chamber provides a maximum surface area of opening by graft 310, so that bone is grown by graft.In one embodiment, inner chamber 332 comprises a width, and it traverses extending more than 60% of graft 310 width 360.In also having another embodiment, inner chamber 332 is along the extension more than 50% of graft 310 length of axis 319.

For placement, can consider any suitable osteogenetic or material or synthetic that bone brings out at the interior intracavity of any graft embodiment as herein described.Such material for example comprises autograft, allograft, xenograft, removes the mineral bone, synthesizes and nature bone graft substitute, such as bioceramic and polymer, and the bone incitant.In the situation of intracavity, before device was transplanted, material can be filled within interior intracavity in advance in bone material is placed into graft.Also can use an independent carrier that material is remained on intracavity in the graft.These carriers can comprise carrier, the bioceramic material of collagen base, such as BIOGLASS , hydroxyapatite and calcium phosphate compound.Carrier material can sponge, form or other suitable form of block, folded sheet, plaster, paste, graft material provide.In addition, be included in bone morphogenetic protein matter that osteogenetic chemical compound in the graft can comprise effective dose, conversion growth factor β 1, the somatomedin 1 of insulin-like, platelet-derived somatomedin, fibroblast somatomedin, lim mineralization protein matter (LMP), and their combination, or remain on a suitable support material interior other treatment or anti-infective.

With reference to Figure 34, the graft 410 of another embodiment shown in the figure.Graft 410 is similar to graft 310, and comprises the end section 411 that a leading edge part 416 is relative with.Graft 410 comprises the arcual lower surface of the convexity that the curved upper surface 414 of convexity is relative with.One the first side wall 413 and relative parallel side wall extend between leading edge part 416 and the end section 411.Tail end or proximal end wall can comprise a hole of as above being discussed for graft 310.Also can provide graft 410, in its tail end wall, not have a hole.A pair of relative groove (groove 424 only is shown) is arranged in the sidewall 313,315, so that as abovely inserted apparatus and engage with one for graft 310 is that discussed.With shown in graft 310 contrast, graft 410 comprises a solid body and along the slick surface topography on its upper and lower surface, so that the supporting maximum of load-bearing surface area.In addition, leading edge part 416 comprises a nose, and nose has along the leading edge surface topography of the arc rounding between sidewall that is formed by radius 420.The surface topography of nose is rounding between the upper and lower surface of graft 410 also.Leading edge nose surface topography can be formed by a plurality of segmental arcs with different radii, and also comprises one or more straightways.

Middle-rounding of the leading edge part 416 between sidewall 413,415 laterally, be convenient to graft 410 is placed in the disk space by tissue.For example, the nose of rounding has been eliminated any lofty angle that is positioned at graft leading edge place.Because slick surface topography, neural structure and other tissue can be pushed out the insertion path of graft.The two-way rounding of leading edge nose, promptly, between the sidewall and between the upper and lower surface at graft, form one enough but can hold the opening of the minimum dimension that graft 410 places by opening contiguous spine and eseparation ring covering weave, this can be convenient to graft 410 is placed in the little opening of anchor ring in-house.Also have very person, in the time of in graft is positioned at disk space, the leading edge nose can be positioned at the limbus corticalis place of the end plate of disk space far-end more easily.Transition position forming with the arcual zone of the depression of vertebral endplate does not embed and is captured in lofty edge or transition on the limbus corticalis.This is convenient to graft 410 and is positioned in the disk space at last.

Graft 410 can be provided with a plurality of holes that are positioned at sidewall, all holes as shown in the figure 420,422.Areole provides an approach for osteogenesis in graft 410, improved its anchoring in disk space in the process that merges.In an illustrated embodiment, provide two holes, but also can consider more than two holes or be less than two holes.The hole can comprise the blind hole that is positioned at graft 410, or can fully extend through with opposing sidewalls in the graft 410 of an open communication.Other embodiment conceives sidewall and is not provided with porose.

With reference to Figure 35, the graft 510 of another embodiment shown in the figure.Graft 510 is similar to graft 410, and comprises the end section 511 that a leading edge part 516 is relative with.Graft 510 comprises the arcual lower surface of the convexity that the arcual upper surface 514 of convexity is relative with.One the first side wall 526 and relative parallel side wall 528 extend between leading edge part 516 and the end section 511.Tail end or proximal end wall can comprise a hole and/or groove 524, so that engage with the insertion apparatus.Graft 510 also comprises an inner chamber 532 that extends and open wide betwixt between upper and lower surface.Sidewall 526,528 comprises the hole 518,520 that is communicated with central lumen 532 respectively.

With shown in graft 310 compare, graft 510 comprises a slick surface topography along its upper and lower surface, comprising the part along inner chamber 532.In addition, leading edge part 516 comprise one between between the sidewall around a radius 512 roundings and the nose of rounding between upper and lower surface also, this just as above discuss for graft 410.

With reference to Figure 36, one inserts apparatus 550 shown in the figure.Insert apparatus 550 and comprise slender axles 552, it extends between a proximal part 554 and the far-

end grip portion

556, and 556 works one of grip portion are connected to graft the connecting elements of axle 552.Proximal part 554 comprises a handle 558 transverse to axle 552 extensions.In one embodiment, handle 558 is directed obliquely so that handle and make insertion apparatus 550 to present various attitudes with respect to axle 552.Axle 552 is projected into a housing parts 560 towards near-end ground from handle 558.Housing parts 560 comprises that one is contained in adjustment member 562 wherein.Axle 564 (Figure 37) extend to far-end grip portion 556 towards far-end from adjustment member 562 and by axle 552 in one.Adjust member 562 finger wheel or other suitable gripping element are provided, so that the surgeon rotates the interior axle 564 in the outer shaft 552, so that the far-end of interior axle 564 engages with a graft.

Far-end grip portion 556 comprise body member 566 and from the opposite side of body member 566 towards a pair of finger-type thing 568,570 that distally extends.In axle 564 far-end from body member 566 towards distally outstanding, and middle heart is positioned between the finger-type thing 568,570.As shown in figure 38, finger-type thing 568,570 is positioned in the corresponding groove that inserts the graft that apparatus 550 engaged, such as the graft in the illustrated embodiment 310.Interior axle 564 is bonded in the interior holes of graft proximal end wall, such as the hole 328 of graft 310.The outer surface of finger-type thing 568,570 flushes or is recessed into respect to the outer lateral surface of graft sidewall, and like this, finger-type thing 568,570 is not from wherein outstanding.When joining graft to, finger-type thing 568,570 forms an overall width, and this width is less than the graft width between the outer lateral surface of its sidewall.This can reduce to the insertion profile of graft and device assembly minimum, and is convenient to be close to the spinal disc space with minimally invasive.

With reference to Figure 39, the insertion apparatus 580 of another embodiment shown in the figure.Insert apparatus 580 and comprise that one can be around the longitudinally mobile outer shafts 582 of an interior axle 584.Insert apparatus 580 and comprise a far-end grip portion 586, it forms a connecting elements so that a graft is connected to interior axle 584.Far-end grip portion 586 comprises that one is positioned at the body member of axle 584 far-ends, and axle 584 comprises a bottom 598 and a pair of biasing member of being separated by central channel 596 588,590 in this.Biasing member 588,590 is formed on the hinge of the activity at 598 places, bottom or one and is connected to each other around one.Finger-type thing 592,594 from the biasing member 588,590 of correspondence towards distally extending.Bottom 598 comprises the outer surface profile of a near-end taper.Outer shaft 582 towards distally and removable along the outer surface profile of bottom 598 at least, so that mobile biasing member 588,590 and finger-type thing 592,594 are toward each other, thereby is caught graft therebetween with respect to interior axle 584.Graft can be by with respect to interior axle 584 near-end ground displacement outer shafts 582, so that biasing member 588,590 and finger-type thing 592,594 move away from each other towards its normal condition.

Can conceive various mechanisms and come mobile outer shaft 582.For example, axle 582,584 can be engaged with each other threadably, and outer shaft 584 rotates around interior axle 582, to realize near-end and motion far-end betwixt.In another example, in the proximal handle actuator is connected to and outer shaft 582,584, and handle can be realized the near-end between the axle and the linear movement of far-end when it is handled.Also can conceive in relative to each other longitudinally moving and other suitable mechanism of outer shaft.

The present invention conceives various programs and apparatus group.For example, by the test body that inserts or the tactile feedback of graft, also can be by the inspection of vision, but whether surgeon's confirmed test body or graft provide the disc space height of expectation.The test body or the graft body that insert should sufficiently stretch remaining anchor ring tissue, to provide firm joint between the upper and lower surface of test body or graft body and adjacent vertebral endplate.Should provide enough surf zone contacts, to prevent or adjacent vertebra is reduced to minimum with respect to the mobile of postoperative of graft.By the graft body that the test body is provided and has the leading edge part of corresponding size and shape, and be inserted in the non-open disk space by testing body and graft body, then test body of Cha Ruing or graft body provide the direct feedback that cooperates expected degree to the surgeon.If second speculum once kept opening, then before speculum was removed, the postoperative of graft cooperated unreliable or (if basic) non-availability to surgical feedback.Like this, but service test body and graft and in test body and graft insertion process, need not utilize outside speculum or remain on speculum in another disk space position.Yet, can use second speculum, in case admissible graft and the test body of removing opens but holding tray is spatial at least in part.For example, an interior stem screw and a bar can be applicable on the offside, so that keep at least in part with the opening of a special graft or the acquisition of test body, yet, no longer need to use them.

In addition, the test body provides graft to insert a kind of indication of mated condition in the disk space position.Because graft comprises leading edge part and corresponding to the height of test body height, so the surgeon can confirm immediately that corresponding graft will be coupled in the space that is occupied by the test body.If speculum remains in the disk space or outside another location, then before graft inserts and removes speculum, do not indicate graft to cooperate suitably.Its result, when speculum was removed, graft may be wedged in the disk space too tightly, if can not get suitable cooperation, made that then removing graft thereafter becomes very difficult.Perhaps, because disk space exceedingly opens, when speculum was removed, it is too loose that graft can become.

Graft is implantable or push in the disk space.Its result, because the side direction of graft in disk space and vertical to taking up an area of the side direction that can occupy with the graft in being close to disk space and vertical identical to occupation of land, so, can reduce to minimum for the disorganization of anchor ring tissue and the approaching flat disk space that collapses.Moreover, by provide laterally and vertically with the advance copy bulk phase with the graft of occupation of land, and open with graft by execution and to insert by identical inlet and path, then in the graft insertion process, do not need additionally to dissect tissue and/or withdraw and adapt to opening of disk space.

Test body and graft can be prepared to be inserted in the disk space by minimum disk space.According to a method, can enter into the flat disk space that collapses, and an opening is formed in the anchor ring, the width that this anchor ring has is corresponding to the width of test body and/or graft.Disk material is removed by the anchor ring opening, if necessary, is removed by the surgeon, implements the coarse processing of craft of end plate with a scraper or the coarse apparatus of other suitable end plate.Test body and/or graft one after the other insert then, if necessary, withdraw from and enter in the disk space by the opening of anchor ring.Because graft is from open, so the end plate that needn't form spine with chisel, drill bit or other method is admitting graft, but such step is not got rid of.Therefore and since eliminated bilateral to open, open the outside, cutter is cut, the requirement of boring and ream etc., so, the less step of need only in the surgical operation.In addition, in disk space, lack other apparatus or install the preparation that can be convenient to the perusal disk space, the insertion of test body, and/or the insertion of graft.Remove the cutting of apparatus in disk space, also improved the safety of operation theoretically.

Can consider the minimally invasive technology of service test apparatus and graft.In any special patient, graft can insert by one in following or their combination: the back to, back-side direction, preceding-side direction, conversion, distally to and/or forward direction approaching.The insertion of graft can take place by a single-pathway, is inserted into one and collapses in the flat disk space, or be inserted into one by a plurality of paths and collapse in the flat disk space, or be inserted into by a plurality of paths on a plurality of height of the flat dish that collapses of spinal column.Because graft is inserted into identical disk space position with test apparatus (if you are using) with identical mean of access, so, insert whole operations of a graft and can finish by a path.If adopt the operation of multipath, then before working in one second path, the surgeon can finish the insertion of graft by a path forming and moving.

Because the insertion of speculum and graft takes place along the identical path of leading to the flat disk space that collapses, so graft and test apparatus are applicable to and utilize a traction apparatus sleeve to provide in the Minimally Invasive Surgery in the path of leading to the flat disk space that collapses.Such traction apparatus sleeve can use any one following technology or their combination: microscopic examination system, fluoroscopic observation, small-sized magnifier, naked eyes and/or image orientation on the telescopic near-end of endoscope's element, traction apparatus in the service aisle.

The test body and the graft body of test apparatus can comprise synthetic or natural autograft, allograft or xenotransplantation fabric texture with any biocompatible material manufacture, and can be to absorb or non-resorbent in itself again.The example of organization material comprises sclerous tissues, conjunctive tissue, removes the bone matrix of mineral, and their combination.Other example of absorbing material is Merlon, polyanhydride, poly-former ester, polyphosphazene, calcium phosphate, hydroxyapatite, the bioactivity glass of polyactide, polysaccharide ester, tyrosine-derived again, and their combination.The enhanced polymer of example right and wrong of non-absorbing material again, the enhanced polymer synthetic of carbon, PEEK and PEEK synthetic, marmem, titanium, titanium alloy, cochrome, rustless steel, pottery, and their combination and other etc.If test body or graft are made by radiolucent material, then the labelling of X-ray radiophotography x can be positioned on test body or the graft, so that the ability with X ray art or cryptoscope technical surveillance and definite body position in the spinal disc space to be provided.Comprise that the material of testing body can be solid, porous, sponge, punching, boring and/or unlimited.

Can consider that a graft is inserted in the spinal disc space between the adjacent vertebra.This graft can be bounced or be pushed in the disk space.Graft can be provided with a size and be suitable for being inserted into collapse flat disk space interior a far-end or a leading insertion end.When graft inserted, graft can return to the flat disk space that collapses the disc space height of one expectation.The disc space height of this expectation is corresponding to the height of the graft of close far-end.In case insert, graft can remain on disk space on the disc space height of expectation.

Can also conceive such graft, when it inserts, its spine and recover and keep the disc space height of an expectation once in the flat disk space that collapses between the spine on one.Graft comprises a body, and body has the make progress upper surface of vertebral endplate orientation of a far-end, a near-end, one day, and one day downward vertebral endplate orientation lower surface.The body of graft has first height between upper and lower surface corresponding to the expectation disc space height.The body of graft also has one second height at its far-end, and it is less than the height of the flat disk space that collapses.

Can conceive graft and can be provided with the upper and lower surface that biconvex goes out curvature, to allow graft centering in the end plate of disk space.The upper and lower surface that can also conceive graft can be a planar shaped, or comprises compound geometric form.The upper and lower surface of graft also can be configured to set up lordosis or prone angle position between the adjacent vertebra body.

Can also conceive one group of graft and have the graft that two or more height increase progressively.The height of each graft is corresponding to a disc space height of recovering.The size of the leading insertion end of each graft is suitable for being inserted into collapses in the flat disk space.When each graft inserted, the disc space height of the recovery that is provided by the graft that inserts was provided the graft flat disk space that will collapse.If the disc space height of recovering does not correspond to the disc space height of expectation, then withdraw from the graft that is inserted, and insert the graft of big height.Proceed to insert in succession and withdraw from the graft that highly increases progressively, till the disc space height of disc space height corresponding to expectation of the recovery that provides by a graft in the graft group.Provide the graft of expectation disc space height to be positioned in the disk space, with the disc space height of recovering and the postoperative maintenance is expected.

Can also conceive a graft group, it has two or more from open test apparatus and at least one graft.Two or more test apparatuses respectively have a body, and the size of the leading insertion end that body has is suitable for being inserted into collapses in the flat disk space.It is substantially the same that each tests the size and dimension of leading insertion end of body.Each is tested body and has one near the height of leading insertion end, and this leading insertion end flat disc space height of will collapsing returns on height that is different from other test body height.At least one graft has a leading insertion end, and the size and dimension of this leading insertion end leading insertion end with at least one test body of testing apparatus basically is identical.Graft has a height near its leading insertion end, the disc space height that this height recovers corresponding to the expectation that is provided by at least one test body.

Can also conceive a cover group that comprises the battery of tests apparatus, each has a test body at its far-end.The test body have one can be inserted in the flat spinal disc space that collapses from open leading edge part.This cover group also comprises one group of graft that is positioned in the flat spinal disc space that collapses.Each graft has a body, and its size and dimension is suitable for the test body corresponding to the correspondence of test apparatus.Each graft body cooperation in the spinal disc space, the cooperation of test body of the correspondence by the test apparatus can be indicated to the surgeon.When a test body provides the cooperation of an expectation, removable test body, and be inserted in the flat disk space that collapses in the occupied position of the test body before withdrawn from corresponding to the graft of this test body.

Can conceive one and insert the lateral sidewall that apparatus can join an intervertebral graft to.Insert apparatus and comprise a far-end coupling part, it is positioned in the groove in the lateral sidewall that is formed on the graft correspondence.The coupling part has the second position that breaks away from the primary importance of graft in the engaging groove and the graft in groove.The width of the coupling part in each primary importance and the second position is less than the width of the graft between the graft lateral sidewall.

Also can conceive and be used for the intervertebral graft is inserted into the whole bag of tricks in the flat spinal disc space that collapses.A plurality of grafts one after the other are inserted in the flat disk space that collapses, to recover disk space.If a specific graft does not return to disk space the disc space height of one expectation, then from disk space, withdraw from this graft.When withdrawing from the graft of an insertion, the disk space right and wrong are open, thereby it is flat to allow to collapse.Provide the graft of expectation disc space height to remain in the disk space, to keep the disc space height of expectation after surgery.

Conceive a kind of method of inserting the intervertebral graft, it comprise from a single inlet near entering in the spinal disc space that collapses flat.One first graft is inserted in the disk space to recover disc space height by inlet.If the disc space height of recovering does not correspond to the disc space height of an expectation, then from disk space, shift out the graft of this insertion, and that disk space allows to collapse is flat.Second graft of one differing heights is inserted in the not open flat disk space that collapses, so that the disc space height of another recovery to be provided.When a graft that inserts provided the disc space height of a disc space height of recovering corresponding to an expectation, the graft of this insertion was retained in the disk space, to keep the disc space height of expectation after surgery.

Also can conceive a method of inserting the intervertebral graft, it comprises and entering in the spinal disc space that collapses flat.A plurality of test bodies are provided with the leading edge part, and its size is suitable for being inserted in the non-open disk space.The advance copy body one after the other inserts in the disk space and from wherein shifting out.Provide the test body of expectation disc space height to be used to select one to have corresponding to the height of the height of the last test body that inserts and leading edge part with from the graft of open leading edge part.Then, this graft is inserted in the non-open disk space, to recover disk space and to keep the disc space height of expectation after surgery.

Although illustrate and describe the present invention in the accompanying drawings with in the above description, they are considered to be used for illustrating, do not limit its feature, and all fall into the variation in the spirit of the present invention and revise and all require to be protected.

Claims

1. graft that is used for spinal column comprises:

One can be positioned on the slender body in the spinal disc space, described body comprise one can be on one the curved upper surface and of the convexity of the end plate orientation of spine can be towards the lower surface of the convexity of the end plate orientation of spine once:

The end section that one leading edge part is relative with one;

The a pair of sidewall that between described leading edge part and described end section, extends;

One inner chamber between described leading edge part, described end section and described sidewall, described inner chamber opens wide at the described upper surface and the described lower surface place of described body; And

Wherein, described body comprises a height between described upper and lower surface, it is corresponding to the disc space height of the expectation between last vertebral endplate and following vertebral endplate, wherein, the structure of described leading edge part is used for being inserted in the disk space that is under the flat state that collapses, in the time of in body is inserted into the flat disk space that collapses, the big young pathbreaker of the described height flat disk space that collapses returns to the disc space height of expectation, wherein

Described upper and lower surface respectively comprises a plurality of engagement members, in the time of in described body is positioned at the spinal disc space, and the therefrom outwards outstanding osseous tissue of engagement member with the joint adjacent vertebral endplate,

Described engagement member comprises the tooth of a plurality of parts of extending along described sidewall along described inner chamber,

Described tooth comprises that respectively one partly is the leading end wall of the gradient towards described leading edge, and a tail end wall relative with described leading end wall, described tail end wall roughly is oriented orthogonally to from the one of corresponding of the arcual upper and lower surface of the described convexity of its extension with respect to described tail end wall.

2. graft as claimed in claim 1 is characterized in that, described upper surface and described lower surface present the arc of convexity separately along whole length of described body.

3. graft as claimed in claim 2 is characterized in that, described leading edge partly comprise one between described upper surface and described lower surface the nose of rounding.

4. graft as claimed in claim 3 is characterized in that described nose is rounding between described sidewall.

5. graft as claimed in claim 1 is characterized in that described sidewall is parallel to each other.

6. graft as claimed in claim 1 is characterized in that, described body comprises:

One is arranged in first first groove of described sidewall; And

One is arranged in second second groove of described paired sidewall, and described first and second grooves open wide at the proximal end wall place of described body.

7. graft as claimed in claim 6 is characterized in that described proximal end wall is planar shaped, and extends between described sidewall and the described upper and lower surface.

8. graft as claimed in claim 6 is characterized in that, comprises that also one has the connecting elements of the first and second finger-type things, and described finger-type thing can be positioned in the groove of correspondence of described first and second grooves, so that described body is fixed to described connecting elements.

9. graft as claimed in claim 8 is characterized in that, described connecting elements comprises that one inserts the distal portions of apparatus.

10. graft as claimed in claim 8 is characterized in that, at least when described finger-type thing is positioned at described groove, described connecting elements at the width between the outer surface of described finger-type thing less than the width between the outer surface of described sidewall.

11. graft as claimed in claim 1 is characterized in that, described upper and lower surface roughly is smooth along described leading edge part and described end section.

12. graft as claimed in claim 1 is characterized in that, also comprises the transitional surface of a rounding that extends between the described leading end wall of each described tooth and described tail end wall.

13. graft as claimed in claim 12 is characterized in that, forms an arc along described body along the described transitional surface of the described tooth on each described upper and lower surface, described arc forms one first radius.

14. graft as claimed in claim 13 is characterized in that, each extends described upper and lower surface along an arc that is formed by second radius, and described first radius is greater than described second radius.

15. the interior graft of disk space that can insert between the adjacent vertebra comprises:

One has the slender body of leading edge part, the size of described leading edge part is suitable for being inserted in non-open, the flat disk space that collapses, described graft has a height between its upper surface and lower surface, when entering in described non-open, the flat disk space that collapses when bouncing described body, this highly is suitable for described non-open, the flat disk space that collapses is returned to the disc space height of an expectation, wherein, described body transplantation is in the disk space that recovers, to keep the disc space height of described expectation after surgery, wherein, described body comprises:

One end section has a proximal end wall opposite with the leading edge nose of described body;

Described upper surface and described lower surface be along described leading edge part and the extension of described end section, and described upper and lower surface respectively comprises the arcual surface topography of convexity between the described proximal end wall of described leading edge nose and described body;

Second sidewall that one the first side wall is relative with one; And

One inner chamber that between described upper and lower surface, extends, described first and second sidewalls and described leading and end section extend around described inner chamber, wherein, described upper and lower surface is smooth substantially along described leading edge part and described end section, wherein, described upper and lower surface respectively comprises a plurality of engagement members, in the time of in described body is positioned at the spinal disc space, engagement member is therefrom outwards outstanding to engage the osseous tissue of adjacent vertebral endplate, and described engagement member comprises the tooth of a plurality of parts of extending along described sidewall along described inner chamber.

16. graft as claimed in claim 15 is characterized in that, described sidewall is parallel to each other.

17. graft as claimed in claim 15 is characterized in that, described leading edge nose is rounding between described upper surface and described lower surface.

18. graft as claimed in claim 17 is characterized in that, described nose is rounding between the opposing sidewalls of described body.

19. graft as claimed in claim 15 is characterized in that, described body comprises:

One is positioned at first groove of a first side wall of described body; And

One is positioned at second groove of one second sidewall of described body, and described first and second grooves open wide at the described proximal end wall place of described body.

20. graft as claimed in claim 19 is characterized in that, described proximal end wall is planar shaped, and extends between described sidewall and the described upper and lower surface.

21. graft as claimed in claim 19 is characterized in that, comprises that also one has the connecting elements of the first and second finger-type things, described finger-type thing can be positioned in the groove of correspondence of described first and second grooves, so that described body is fixed to described connecting elements.

22. graft as claimed in claim 21 is characterized in that, described connecting elements comprises that one inserts the distal portions of apparatus.

23. graft as claimed in claim 21 is characterized in that, at least when described finger-type thing is positioned at described groove, described connecting elements at the width between the outer surface of described finger-type thing less than the width between the outer surface of described sidewall.

24. graft as claimed in claim 15, it is characterized in that, described tooth comprises that respectively one partly is the leading end wall of the gradient towards described leading edge, and a tail end wall relative with described leading end wall, described tail end wall roughly is oriented orthogonally to from the one of corresponding of the described upper and lower surface of its extension with respect to described tail end wall.

25. graft as claimed in claim 24 is characterized in that, also comprises the transitional surface of a rounding that extends between the described leading end wall of each described tooth and described tail end wall.

26. graft as claimed in claim 25 is characterized in that, forms an arc along described body along the described transitional surface of the described tooth on each described upper and lower surface, described arc forms one first radius.

27. graft as claimed in claim 26 is characterized in that, each extends described upper and lower surface along an arc that is formed by second radius, and described first radius is greater than described second radius.